GM Devolution: CAMHS Revolution An Opportunity for Community Eating Disorders Dr Sandeep Ranote GM NHSE & GM Devolution CAMHS Clinical Network Lead
IN THE SPOTLIGHT Katie s Story http://www.bbc.co.uk/news/health-35576774
WHY, HOW & WHEN? 1 in 150 female YP anorexia nervosa (AN) 1 in 25 female in lifetime bulimia nervosa (BN) 90% female 1.6 million UK people directly affected BEAT 2007 High rates of co-morbidity AN highest mortality of any psychiatric disorder Geographical variations in service provision still high Total annual UK cost 1.2 bn - 9.6 bn BEAT review 2012 & 2014 Carer burden high and underestimated CAMHS use of tier 4 admission for ED high > 35% Often due to poor/no specialist community or mini team provision
WHY, HOW & WHEN? Wigan pilot (> 200 families) demonstrates need > 90% families treated rated service 4/5 out of 5 > 90% families would recommend service (F & F test) > 85% improved outcomes 10-12% admission rate to Tier 4 Increase in admissions seen in 2013 with national picture
WHY, HOW & WHEN? Evidence base supports CEDS-CYP community adolescent eating disorder service as most cost effective MDT integrated model recommended Partnership working Critical window for intervention 3-5 years Clear transition pathway Multimodal therapeutic package of care, person centred, evidence based, National clinical outcome measures (DATA!) EARLY INTERVENTION KEY delay increases long term health costs Shared decision making Experts by experience to co-develop pathways Recovery Model More studies underway
ASPIRATIONS Education and training in primary care and schools Junior MARSIPAN in reach to paediatric ward / Junior MARSIPAN hub Day unit Tier 4 provision 0-25 or ageless service Peer Mentoring Parent Support Groups led by parents Primary care / schools link
WHAT NOW? 30m recurrent funding Autumn budget 2014 150m in total over 5 years Transformation of services in England for children and young people with eating disorders up to 18 years old Development of CEDS-CYP Population minimum for service 500k (all ages) Access and waiting time standards guide July 2015 National whole team training curriculum 2016 QNCC CEDS-CYP Standards - 2016
WHAT NOW?
Proposed CEDS-CYP Pathway
SCHOOLS LA THIRD SECTOR COLLABORATION Beat Schools Programme General Community NWBP CAMHS CAMHS Urgent Response Team Fairhaven 5 YEAR PLAN DEVELOP 2 SPECIALISED BEDS & DAY SERVICE CEDS PRIMARY CARE LINK WORKER HALTON CEDS SPOKES SPECIALIST MDT WARRINGTON WIGAN / BOLTON GM DEVO NON NWBP WWL PAEDS HUB CEDS SCHOOLS LINK WORKER KNOWSLEY WHISTON PAEDS HUB ST HELENS THE HOUSE OF CEDS PAEDS PSYCHIATRY CYP IAPT FAMILY THERAPY CASE COORDINATION CBT MOTIVATIONAL THERAPY DIETETICS OTHER EVIDENCE BASED THERAPIES GM DEVO CLUSTERS GM TIER 4 ED UNITS
Real People, Real Stories, Real Revolution https://youtu.be/bs02_7pvsia
Community Eating Disorder Service Population-based: minimum 500K (all ages) so may span more than one CCG Referrals for anorexia nervosa, bulimia nervosa, binge eating disorders and co-existing problems (e.g. anxiety and depression) Min of 50 referrals per year Enable direct access to community eating disorder treatment via self-referral, GPs, schools, colleges and voluntary sector
GM DEVO
GM ED Network Workforce training (National WTT Programme NHSE 2017-2018) Sharing and learning Best practice models GM standards & public awareness Shared digital solutions Future development Single site / 2 site Tier 4 GM beds 4 GM kids Single site / 2 site day provision GM DEVO
GM DEVO Pathway in partnership with VCS (Beat) schools programme Primary care work Thrive compliant Co-developed KPIs Crisis Care Linked GM Single Service specification
Thrive Model
Devolution Data West AWT = 66.7% East (North/South Hub) AWT = data incomplete Central AWT = 100%
Children & Young People A third of our population BUT all Of our future